Decrying medical racism, Indigenous leaders demand health care ‘transformation’

Canada must “transform” the discriminatory health care it offers Indigenous peoples, leaders demand after a series of troubling incidents across the country.

On Wednesday, the federal government hosted a virtual cross-country event with Indigenous health leaders to examine ways to end racism in the medical system, at which Ottawa admitted “there is systemic racism in the health-care system.”

According to veteran Manitoba family physician Dr. Barry Lavallee, CEO of the northern Manitoba First Nations’ health organization Keewatinohk Inniniw Minoayawin, the problem is at once frustrating, longstanding and deeply entrenched.

"As a provider working in our communities, not only are you concerned about your patients in front of you, but you have to work within a system that actually cannot address the health concerns of First Nations and Métis people,” Lavallee, who is Métis, told Windspeaker.com in an interview. “As an Indigenous physician, arguing about whether racism exists and whether it impacts health outcomes for people is extremely frustrating.

“When an Indigenous person enters a health care system, be it a clinic, emergency room, a hospital, they’re automatically segregated within the minds of the settler.”

The latest in a long string of allegations of racism within the healthcare system was the treatment of Carol Wood of O-Pipon-Na-Piwin Cree Nation in northern Manitoba. On Jan. 11 Wood broke her leg in a car accident, but was sent home without an x-ray from the local clinic.

Her husband, Councillor Brian Wood, recounted driving her four hours over rough roads himself to the nearest city’s emergency room for what she knew all along was a badly broken leg, so severe the hospital airlifted her in the middle of the night to Winnipeg for surgery.

“She was just screaming in pain,” Wood said at a press conference on Tuesday. “One of the nurses … said the leg didn’t appear to be broken, and wasn’t even there five minutes and left.

“My wife (asked) if she could get a re-evaluation. She said, ‘No, you can take her home.’ Her leg started swelling up and turning blue.”

Wood said his wife remains on antibiotics and has a 14-inch scar on her leg.

“I find that very appalling. Nobody should be treated that way regardless of whether it’s in a First Nation,” he said.

It’s hardly the first such incident to make headlines, nor the first time suspicions were raised about the reason for substandard care, bringing to mind Manitoba’s inquest into the 2008 death of Sagkeeng First Nation member Brian Sinclair. He died after being ignored 34 hours in an emergency department waiting room.

The issue exploded again last September when 37-year-old Atikamekw woman Joyce Echaquan died in a Quebec hospital after unsuccessfully trying to tell nurses she was allergic to morphine.

What set her case apart was she livestreamed the moments before her death on social media, including hospital staff’s racist and sexist comments that she was only “good for sex” and “stupid as hell.” It sparked investigations and apologies.

And last summer, British Columbia’s government tasked University of B.C. law professor Mary Ellen Turpel-Lafond with investigating allegations of health care racism in the province. Her report was scathing and unequivocal: “Widespread systemic racism against Indigenous peoples … has long been known by many within the healthcare system.”

For those like Turpel-Lafond, who have investigated such incidents, Echaquan’s treatment was “traumatizing” but hardly a surprise, the Cree former judge said.

“The shocking part about what happened to Joyce Echaquan in Quebec was the fact that she livestreamed on Facebook her treatment,” said Turpel-Lafond, who directs UBC’s Indian Residential School History and Dialogue Centre. “She was desperately trying to reach her family.”

Another incident, this time in an Alberta hospital last Dec. 25, sparked outrage on Tuesday, and a complaint to that province’s College of Physicians and Surgeons.

Lillian Vanasse of Sandy Bay Ojibway First Nation went to hospital with severe flu-like symptoms and trouble breathing, the most common signs of COVID-19.

Despite pleas for help, according to the Southern Chiefs Organization, she was “not given proper treatment such as oxygen,” and died the next day.

The federal government’s national online event Wednesday and Thursday “Addressing Anti-Indigenous Racism in Canada’s Health Care Systems” is attended by Indigenous leaders and health providers.

Speaking at the event, federal Indigenous Services Minister Marc Miller said even though health care is under provincial jurisdiction, First Nations are Ottawa’s responsibility and all levels of government must act.

“There is systemic racism in the health-care system in every province and in every territory,” Miller told attendees. “When it comes to issues like racism, systemic racism, discrimination, every leader in this country has a leadership role to play in calling it out and getting rid of it.”

But the time for studies, inquiries and talking is long past, said Grand Chief Garrison Settee of Manitoba Keewatinowi Okimakanak, which represents 26 northern Manitoba First Nations.

“Talking about it will not make it go away,” he said at a press conference Tuesday. “We’re urging the government to take action to ensure that our Indigenous people are treated fairly … Apparently in our healthcare system, this is not the case.”

One way some First Nations are addressing the problem is with dedicated staff on call to advocate for patients who are finding barriers to getting care.

For instance, MKO offers such a service to Indigenous people known as “client navigators.” Such a support person, if called on by a patient “provides support and advocacy to help First Nations people and Inuit” and “will advocate with the federal government and health professionals to resolve issues.”

In addition to the client navigators, Dr. Lavallee said his organization is also set to launch a dedicated office to address racism, hiring six full-time advocates with skills in law, complaints processes and health systems “to support First Nations people seeking justice in care,” Lavallee said. That could include suing governments to hold them accountable.

For Turpel-Lafond, the impacts of racist stereotypes among health care professionals can be deadly. Those stereotypes, she found in her B.C. investigation, included commonly held views of Indigenous people as alcoholic, “drug-seeking,” “bad parents,” “frequent fliers” (people, often who are mentally ill, who make repeated and frequent visits to emergency departments and psychiatric centers), and many specifically targeted women.

“These types of stereotypes do result in discrimination at the point of care,” she said, “including many abusive interactions with the patient and also resulting in ignoring, shunning or denial of service, and even medical mistakes.”

Her 24 recommendations included passing a law to "hard-wire" cultural safety into healthcare, strengthen patient complaints processes and health worker whistleblower protections, and to appoint a provincial Indigenous Health Officer, as well as an independent watchdog and advocate for Indigenous health.

As a long-time family physician himself, Dr. Lavallee wishes the experiences of racism didn’t stop Indigenous people from seeking the medical help they need, and he urged Indigenous patients to believe their experiences and to seek help “fighting for change.”

“I want people to know what you’re experiencing is true,” he said. “For our own communities, we have to be educated about what racism looks like so we understand our human rights.

“You don’t need verification from colonial systems. We have to support each other in that way.”

For Grand Chief Settee, the string of troubling incidents in his own region and across the country has him asking if Canada has a type of medical apartheid.

“Apparently there’s two types of healthcare systems in our nation,” Settee lamented, “one for the rest of Canadian society, and one for Indigenous people where they’re treated unfairly, mistreated and forced to go through undue hardship. We’re asking for transformation.”

Local Journalism Initiative Reporters are supported by a financial contribution made by the Government of Canada.